A prospective audit of decision to delivery interval among women having emergency caesarean section

Aim To assess decision to delivery interval (DDI) among women requiring caesarean section (CS) for category I&II. To examine factors associated with delay of time. To compare spinal and epidural top-up anaesthetic, in these cases. Methods Data were collected prospectively for all women having CS for grade I&II. Special data collection form was designed looking for time interval from diagnosis to arrival in theatre, start of the operation, and time of delivery. Secondary outcome measures included cord PH, rate of postpartum haemorrhage and intra-operative complications. We have excluded cases of trial of instrumental delivery from the study. Results One hundred and seventy one patients were examined including 27 cases of Grade I CS and 144 cases of Grade II CS. Out of 27 women with grade I CS 12 had CS under spinal anaesthetic with median DDI 33 min (range 16-51) and epidural top-up in 15 cases with median DDI 23 min (16-44). Out of 144 grade II CS, 38 women had CS under spinal anaesthesia with a median DDI 50 (20-133) and epidural top-up in 106 with a median DDI 45 min (19-185). Low cord PH was observed in 11.1% of grade I CS and in 6.9% of grade II CS. Conclusion The duration of DDI is quite variable among women having emergency CS. Each unit need to assess its own rate and analyse cause for delay and impact on neonatal outcome.